Elizabeth Phillips Broullire

Primary specialty

PharmacistTaxonomy code 183500000X

License

PS 51887 Issued in FL

Practice address

630 Atlantic Blvd.
Neptune Beach, FL 32266

Phone

(904) 249-1725

NPI assigned

Aug 25, 2014

Last updated

Dec 16, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Publix Super Markets Inc

  dba Publix Pharmacy #2107

  • Community/Retail Pharmacy
  • Winter Haven, FL
  • NPI 1760356380
  NPD (past)
• Publix Super Markets Inc

  dba Publix Pharmacy #1367

  • Community/Retail Pharmacy
  • Neptune Beach, FL
  • NPI 1790724649
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1408924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481846400000",
    "number": "1689074817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 ATLANTIC BLVD",
            "city": "NEPTUNE BEACH",
            "state": "FL",
            "postal_code": "322664000",
            "telephone_number": "904-249-1725",
            "fax_number": "904-249-0292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 ATLANTIC BLVD.",
            "city": "NEPTUNE BEACH",
            "state": "FL",
            "postal_code": "32266",
            "telephone_number": "904-249-1725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROULLIRE",
        "first_name": "ELIZABETH",
        "middle_name": "PHILLIPS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-25",
        "last_updated": "2016-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS 51887",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH028141",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA PHARMACIST LICENSE",
            "identifier": "PS 51887",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GA BOP",
            "identifier": "RPH028141",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Baptist Agewell Physicians Inc
• Karen Marie Basile, A.P.
• Biopsy Diagnostics, PC (BXDX Clinical Laboratories)
• Mindy Coker Black, MS,RD,CSSD,CPT
• Body Works Studio Inc
• Andrew Bruhl, CPT
• Robert Byars II, PTA
• Cancer Specialists, LLC (Cancer Specialists of NF)
• Cynthia B. Carey, P.T.
• Laura Busch Carper, PH.D.

• Pharmacist in Neptune Beach, FL
• Providers in Neptune Beach, FL by specialty
• Pharmacist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.